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optic neuritis


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case presentation of optic neuritis

Published in: Health & Medicine
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optic neuritis

  1. 1. Clinical case presentation Dr. Samten Dorji
  2. 2. Chief complaint • 33 year old male presented to our OPD with blurring of vision for one month duration.
  3. 3. Personal details He is from Sephu,Wangdue currently working as teacher in Langthel,Trongsa.he is married and has two children.
  4. 4. History of present illness • A month back he had an acute onset of blurring of vision in both eyes and he could see movement of letters in his computer desktop. There was no associated ocular pain. • During the month there was no worsening progression of his vision or improvement but it stayed the same. • Patient complains of increase in contrast of colors
  5. 5. Negative findings in history • No focal neurological weakness • No history of viral flu prior to that condition • No pets in house
  6. 6. History cont. • Past ocular history/ocular medications/systemic medications/comorbidities/allergies/family history • Patient drinks alcohol daily two bottles of beer and has history of alcohol misuse for 9 years and has history of smoking filtered cigarettes half packet per day for 9 years.
  7. 7. Examination Right eye Left eye Visual acuity FC 1m FC 1m With pinhole FC 1m FC 1m Color vision Can read plate 1 Cannot read 5,6,9,10,12,13,14,1,7,26,2 5,27,30,32,33 Can read plate 1 Cannot read 5,6,9,10,12,13,14,1,7,2 6,25,27,30,32,33 Extraocular movements Normal Normal Lids and adnexa Lower lid epiblepharon Lower lid epiblepharon Conjunctiva and sclera normal normal Cornea clear clear Anterior chamber Normal depth and quiet Normal depth and quiet Iris and lens Normal Normal
  8. 8. Examination Pupil Round regular and sluggish reflex No RAPD Round regular and sluggish reflex No RAPD IOP by Icare tonometer 13 mmhg 15 mmhg
  9. 9. Fundus examination Disc oval hyperemic and blurry margin Cup disc ratio 0.2 : 1: 0.2 Foveal reflex present Vessels look normal Periphery normal
  10. 10. Systemic examination • General appearance: mild facial puffiness and tremor of hands • Weight=49 Kg • CVS: PR=100bpm , BP= 120/70, heart sounds normal • RS: RR=20/min chest clear • Abdomen: unremarkable • Neurological system: unremarkable
  11. 11. Case summary • 33 year old male, a known alcohol misuser, had acute onset of blurring of vision one month back with no progression. On eye examination he had visual acuity of FC1m with pinhole correction in both eyes with bilateral APD with disc edema on fundus examination. He has bilateral lower lid epiblepharon. On systemic examination he had signs suggestive of alcohol withdrawal syndrome.
  12. 12. Problems 1. Reduction of vision with APD and disc oedema 2. Alcohol withdrawal syndrome 3. Bilateral lower lid epiblepharon
  13. 13. Differential diagnosis 1. Acute demyelinating optic neuritis Supporting points • Age=33 years • Acute onset of blurring of vision • Impaired contrast sensitivity and color vision • APD in both pupils • Disc oedema on fundus examination Non- supporting points • No ocular pain or with ocular movement also • No worsening or improvement over the period of one month • Both eyes less common
  14. 14. Differential diagnosis 2. Nutritional optic neuropathy Supporting points • Has a history of alcohol misuse • Symmetrical bilateral visual impairment • Color vision impairment • Disc oedema Non-supporting points • Acute onset of disease
  15. 15. Differential diagnosis 3. Neuroretinitis Supporting points • Painless acute loss of vision • Disc oedema Non-supporting points • Usually unilateral • No history of pets in house • No macular involvement
  16. 16. Differential diagnosis 4. Anterior ischemic optic neuropathy Supporting points • Sudden onset of loss of vision • Disc oedema Non-supporting points • Affects >50 years • Usually unilateral
  17. 17. Differential diagnosis 5.Parainfectious optic neuritis 6. Infectious optic neuritis 7.Non-infectious optic neuritis
  18. 18. Investigation
  19. 19. Management Managed as acute demyelinating optic neuritis • IV methyl prednisolone 500mg 12 hourly for 3 days followed by 1mg/kg(50mg) OD for 11 days • Tablet ranitidine 150mg bd • Artificial tears eye drops • Referral to psychiatry for alcohol withdrawal syndrome • Vitamins
  20. 20. Subject review